Anti anginal Agents /certified fixed orthodontic courses by Indian dental academy

Antianginal Agents

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Antianginal Agents
Nitrates
Beta blockers
Calcium channel blockers


Angina Pectoris (Chest Pain)
When the supply of oxygen and nutrients in the

blood is insufficient to meet the demands of the
heart, the heart muscle aches.
The heart demands a large supply of oxygen to meet
the demands placed on it.


Types of Angina
Chronic stable angina
(also called classic or effort angina)
Unstable angina
(also called preinfarction or crescendo angina)
Vasospastic angina
(also called Prinzmetal’s or variant angina)


Antianginal Agents:
Therapeutic Objectives
Increase blood flow to ischemic heart muscle

and/or
Decrease myocardial oxygen demand


Antianginal Agents:
Therapeutic Objectives
Minimize the frequency of attacks and decrease the

duration and intensity of anginal pain
Improve the patient’s functional capacity with as few side
effects as possible
Prevent or delay the worst possible outcome, MI


Antianginal Agents: Nitrates
Available forms:
Sublingual
Buccal
Chewable tablets
Capsules

Ointments
Transdermal patches
Inhalable sprays
Intravenous solutions


Cause vasodilation due to relaxation of smooth

muscles

Potent dilating effect on coronary arteries
Used for prophylaxis and treatment

of angina


Nitroglycerin
Prototypical nitrate
Large first-pass effect with PO forms
Used for symptomatic treatment of ischemic heart

conditions (angina)
IV form used for BP control in perioperative hypertension,
treatment of CHF, ischemic pain,
and pulmonary edema associated with acute MI


isosorbide dinitrate

(Isordil, Sorbitrate, Dilatrate SR)
isosorbide mononitrate
(Imdur, Monoket, ISMO)

Used for:
Acute relief of angina
Prophylaxis in situations that may provoke angina
Long-term prophylaxis of angina


Side Effects
Headache
Usually diminish in intensity and frequency

with continued use
Tachycardia, postural hypotension
Tolerance may develop


Antianginal Agents: Beta
Blockers
atenolol (Tenormin)
metoprolol (Lopressor)
propranolol (Inderal)
nadolol (Corgard)


Blockers
Mechanism of Action
Decrease the HR, resulting in decreased myocardial

oxygen demand and increased oxygen delivery to the heart
Decrease myocardial contractility, helping to conserve
energy or decrease demand


Blockers
Therapeutic Uses
Antianginal
Antihypertensive
Cardioprotective effects, especially after MI


Blockers
Side Effects
Body System
Cardiovascular

Metabolic

Effects
bradycardia, hypotension
second- or third-degree heart block
heart failure
Altered glucose and lipid
metabolism


Blockers
Side Effects
Body System

Effects

CNS
dizziness, fatigue,
mental depression, lethargy,
drowsiness,
unusual dreams
Other
impotence
wheezing, dyspnea


Antianginal Agents:
Calcium Channel Blockers
verapamil (Calan)
diltiazem (Cardizem)
nifedipine (Procardia)


Antianginal Agents:
Mechanism of Action
Cause peripheral arterial vasodilation
Reduce myocardial contractility

(negative inotropic action)
Result: decreased myocardial oxygen demand


Antianginal Agents:
Therapeutic Uses
First-line agents for treatment of angina, hypertension,

and supraventricular tachycardia
Short-term management of atrial fibrillation and flutter
Several other uses


Antianginal Agents:
Side Effects
Very acceptable side effect and safety profile
May cause hypotension, palpitations, tachycardia

or bradycardia, constipation, nausea, dyspnea


Antianginal Agents:
Nursing Implications
Before administering, perform a complete health

history to determine presence of conditions that may
be contraindications
for use or call for cautious use.

Obtain baseline VS, including respiratory patterns

and rate.

Assess for drug interactions.


Antianginal Agents:
Patients should not take any medications, including

OTC medications, without checking with the
physician.

Patients should report blurred vision, persistent

headache, dry mouth, dizziness, edema, fainting
episodes, weight gain of
2 pounds in 1 day or 5 or more pounds in
1 week, pulse rates under 60, and any dyspnea.


Antianginal Agents:
Alcohol consumption and hot baths or spending

time in jacuzzis, hot tubs, or saunas will result in
vasodilation, hypotension, and the possibility of fainting.
Teach patients to change positions slowly to avoid
postural BP changes.
Encourage patients to keep a record of their anginal
attacks, including precipitating factors, number of pills
taken, and therapeutic effects.


Antianginal Agents: Nitroglycerin
Instruct patients in proper technique and guidelines for

taking sublingual NTG for anginal pain.
Instruct patients never to chew or swallow the
SL form.
Instruct patients that a burning sensation felt with
SL forms indicates that the drug is still potent.


Instruct patients to keep a fresh supply of NTG on hand;

potency is lost in about 3 months after the bottle has been
opened.
Medications should be stored in an airtight, dark glass
bottle with a metal cap and no cotton filler
to preserve potency.


Instruct patients in the proper application of nitrate

topical ointments and transdermal forms, including site
rotation and removal of old medication.
To reduce tolerance, the patient may be instructed to
remove topical forms at bedtime, and apply new doses in
the morning, allowing for a nitrate-free period.


Instruct patients to take prn nitrates at the first hint

of anginal pain.
If experiencing chest pain, the patient taking SL NTG
should be lying down to prevent or decrease dizziness and
fainting that may occur due to hypotension.
Monitor VS frequently during acute exacerbations
of angina and during IV administration.


IV forms of NTG must be contained in glass IV bottles and

must be given with infusion pumps.
Discard parenteral solution that is blue, green,
or dark red.
Follow specific manufacturer’s instructions for IV
administration. Use special IV tubing provided or nonPVC tubing.


Antianginal Agents:
Blood levels should be monitored to ensure they

are therapeutic.
Oral CCBs should be taken before meals and
as ordered.
Patients should be encouraged to limit
caffeine intake.


Antianginal Agents: Beta Blockers
Patients taking beta blockers should monitor pulse rate

daily and report any rate lower than 60 beats per minute.
Dizziness or fainting should also be reported.
Constipation is a common problem. Instruct patients to
take in adequate fluids and eat high-fiber foods.


Antianginal Agents: Beta Blockers
These medications should never be abruptly discontinued

due to risk of rebound hypertensive crisis.
Inform patients that these medications are for
long-term prevention of angina, not for
immediate relief.


Antianginal Agents:
Monitor for adverse reactions
Allergic reactions, headache, light-headedness,

hypotension, dizziness

Monitor for therapeutic effects
Relief of angina, decreased BP, or both


Leader in continuing dental education


Anti anginal Agents /certified fixed orthodontic courses by Indian dental academy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (12)

Similar to Anti anginal Agents /certified fixed orthodontic courses by Indian dental academy

Similar to Anti anginal Agents /certified fixed orthodontic courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Anti anginal Agents /certified fixed orthodontic courses by Indian dental academy

Editor's Notes